Kaiser Daily Global Health Policy Report

In The News

“Human rights lawyers representing Haitian victims of a cholera epidemic they blame on U.N. peacekeepers announced on Wednesday they were filing a lawsuit against the United Nations, with a New York court seeking compensation from the world body,” Reuters reports. “‘The plaintiffs include Haitians and Haitian Americans who contracted cholera themselves as well as family members of those who died of the disease,’ the Institute for Justice and Democracy in Haiti [IJDH] said in a statement,” which also “said lawyers were filing the suit in the U.S. District Court in New York’s Southern District,” the news agency notes (Charbonneau, 10/9). “The lawsuit … will be the strongest action they have taken in pressing the United Nations to acknowledge at least some culpability for the outbreak of cholera,” the New York Times reports (Gladstone, 10/8). “The U.N. [previously] has cited its immunity, and has not accepted responsibility for the epidemic, even though medical experts — including members of an independent panel appointed by the U.N. — agree that the disease was probably introduced by U.N. peacekeepers,” NBC News notes. “Though the U.N. has committed hundreds of millions of dollars to fight the disease [in Haiti], it has not indicated a willingness to settle individual claims from victims,” NBC writes.

“The IJDH suit … goes beyond placing blame on the U.N., accusing the international body of covering up its role in introducing the disease,” NBC states. According to NBC, “the IJDH is asking for an unspecified amount for victims, and for the U.N. to make improvements to Haiti’s water and sanitation infrastructure that are projected to cost $2.4 billion” (Schecter, 10/8). Making “a rare case for compensation,” U.N. High Commissioner for Human Rights Navi Pillay on Tuesday said, “I have used my voice both inside the United Nations and outside to call for the right — for an investigation by the United Nations, by the country concerned, and I still stand by the call that victims of — of those who suffered as a result of that cholera be provided with compensation,” according to the Associated Press/Miami Herald. Asked about the comments, “U.N. associate spokesman Farhan Haq said it is not the ‘United Nations’ practice to discuss in public claims filed against the organization,'” the AP writes (Daniel/Lederer, 10/8). NBC’s Nancy Snyderman reports from Haiti on the cholera epidemic and the class-action lawsuit (10/8).

“Experts in Africa, the continent worst-hit by malaria, reacted with optimism but also caution on Tuesday to news that the first vaccine against the killer disease may soon reach the market,” Agence France-Presse reports. “GlaxoSmithKline said it was seeking approval for a prototype vaccine that reduced the risk of malaria by almost half among children aged between five and 17 months, and by around a quarter among infants aged between six and 12 weeks,” according to the news agency, which notes “the vaccine could be rolled out within two years” if it is approved by the European Medicines Agency. AFP includes comments from Nilton Saraivo, a manager of Angola’s national anti-malaria program; Bertrand Lell of the Lambarene Centre for Medical Research; John Gikapa, a technical adviser to SANRU in the Democratic Republic of Congo; Lucas Otieno of the Kenya Medical Research Institute; and Martin de Smet, a malaria specialist with Médecins Sans Frontières (10/8). “Although the vaccine’s efficacy is far from ideal, some researchers contend that it could add a critical new tool to malaria prevention efforts,” ScienceNow reports. “In particular, a modestly effective vaccine combined with insecticide-treated bed nets, spraying efforts, and improved diagnostics could have an important additive effect,” the news service notes and includes comments from Richard Feachem, a malaria specialist at the University of California, San Francisco (UCSF), and David Kaslow, who heads the PATH Malaria Vaccine Initiative, which is involved in the trials (Cohen, 10/8).

Denis Broun, executive director of UNITAID, on Tuesday urged Japan “to introduce a so-called ‘solidarity levy,’ such as a small tax on airline ticket purchases,” to help support the organization’s goal of improving “access in low-income countries to diagnostics and treatments for HIV/AIDS, malaria and tuberculosis,” Kyodo News International/GlobalPost reports. He “told a press conference in Tokyo that the levy would serve to supplement Japan’s official development assistance budget, which has been shrinking due to the nation’s tight fiscal situation,” according to the news agency. “UNITAID first asked for Japan’s support in 2010 and the government and lawmakers have since shown better understanding of the levy, Broun said,” the news agency writes, adding, “UNITAID has 29 member countries, with about 70 percent of its funding coming from air ticket levies” (10/8).

In collaboration with GlobalPost, “[t]he Forum at the Harvard School of Public Health will host a panel on Wednesday about the steps that can be taken to reduce child mortality around the world,” GlobalPost’s “Pulse” blog reports, noting that the discussion will be live streamed on the blog. “The panel discussion comes weeks after UNICEF released its 2013 progress report on child survival. … The event also follows up on a special report published by GlobalPost titled ‘Step by Step: The Path to Ending Child Mortality,'” the blog notes (10/8).

“According to the World Bank, Guatemala has the third-highest rate of chronic malnutrition, or stunted growth,” in the world, The Guardian reports. However, “[r]educing malnutrition is a priority for the government,” the newspaper states, noting a recent visit by Guatemala Vice President Roxana Baldetti to Pamumus, a village outside Guatemala City. “The [centerpiece] of Guatemala’s struggle against undernourishment is its zero-hunger plan that aims to reduce chronic malnutrition in under-fives by 10 percent by 2016,” the newspaper writes, adding that Guatemala President Otto Pérez Molina recently spoke about his government’s efforts to reduce hunger at the U.N. General Assembly. “Last week, the [European Union] announced it would provide up to €775 million [$1.05 billion] for bilateral assistance to Nicaragua, El Salvador, Guatemala and Honduras between 2014-20,” pending approval, the newspaper notes. E.U. Commissioner for Development Andris Piebalgs also visited Pamumus, saying, “We can really do something [in Guatemala], be a game-changer in areas like nutrition,” according to The Guardian (Tran, 10/9).

Editorials and Opinions

Universal health coverage (UHC) “could transform the lives of millions of people by bringing life-saving health care to those who need it most,” Oxfam International Executive Director Winnie Byanyima writes in the Huffington Post’s “World” blog. “But some donors and developing country governments have been promoting health insurance schemes as the solution to reaching UHC. Oxfam believes this is misguided,” she states, adding “in some cases this is actually increasing inequality, because these insurance schemes prioritize those who are already better-off and leave the poorest and most marginalized people — especially women — behind.” Byanyima continues, “On the flip side, a growing number of developing countries including Brazil, Malaysia, Mexico and Thailand have built home-grown health financing systems that are actually working well. Rather than trying to collect insurance premiums from those who are too poor to pay, they have prioritized general government spending for health.” She states, “In fact, the only low-income countries to have achieved universal and equitable health coverage have done it by relying mainly on tax, rather than insurance.” Byanyima adds, “Donors need to recognize that health insurance schemes do not tend to reach poor people and are typically bad for the health of poor countries” (10/8).

Rwandan Prime Minister Pierre Damien Habumuremyi writes in The Guardian’s “Global Development Professionals Network” blog about his country’s progress toward meeting the Millennium Development Goals (MDGs). “While the government in Kigali plays a central coordinating role, Rwanda’s success has been driven by the way services and programs have been delivered at the village level through communities taking charge of their own lives,” Habumuremyi writes. He notes the importance of government security, “a sound and predictable regulatory environment, robust institutions and zero tolerance of corruption,” as well as “transparency and accountability at all levels.” Habumuremyi says civil society involvement also is critical for reaching the MDGs. “As President [Paul] Kagame told the U.N. last week: ‘For Rwanda, the MDGs are a floor, not a ceiling,'” he states, concluding, “Our country’s achievement so far — and the achievements to come — are a true national effort driven and delivered by our citizens” (10/8).

Noting Russian President Vladimir Putin’s “new ban on ‘homosexual agendas,'” Frank Wong, an associate professor in the Rollins School of Public Health at Emory University, writes in an Al Jazeera opinion piece, “Putin’s anti-homosexuality agenda is only one part of a much larger problem. Not all Russian citizens are entitled to the same level of civil liberties, social benefits, and welfare.” He continues, “Among the most harshly affected by this disparity are injection drug users — the overwhelming majority of whom are men — and men who have contracted HIV due to having sex with other men who are HIV-positive,” who, together, make up “more than 80 percent of Russia’s one million HIV/AIDS cases.” HIV-positive men who have sex with men (MSM) and “injection drug users are not eligible for medical treatment of any kind; it is illegal for the state or for private doctors to provide such treatment,” Wong notes. “Prejudice and stereotyping are not limited to Russia,” Wong states, adding, “For many people, including educated and learned professionals, such as doctors and lawyers, there remains an underlying misconception that men who have sex with men and injection drug users cannot be productive or moral citizens — even in the ‘developed’ world.” He continues, “Ensuring that people are treated for HIV and AIDS isn’t simply a public health issue, but a question of human rights” (10/8).

Recent Releases

“In this week’s PLOS Medicine, two independently written articles call for a shift away from the leader-centric approach that polio eradication campaigns are currently pursuing in the three countries (Nigeria, Pakistan and Afghanistan) where the disease remains endemic,” a PLOS press release states. “In a policy forum article, authors from Nigeria, Pakistan and Afghanistan led by Seye Abimbola from the National Primary Health Care Development Agency, Nigeria, argue that the global health community and governments involved in polio eradication efforts need to build trust and prioritize polio eradication as part of routine health services in order to address the problem of polio,” the press release notes. “In an independently written essay, Svea Closser and Rashid Jooma from Middlebury College, United States, and Aga Khan University, Pakistan, highlight the importance of Lady Health Workers in Pakistan who are crucial for the country’s polio eradication efforts,” the press release adds (10/8).

In a BMJ Group Blogs post, Richard Smith, former editor of the BMJ and director of the United Health Group’s chronic disease initiative, writes “about the four phases of global health,” first described by Peter Piot, director of the London School of Hygiene and Tropical Medicine, and discussed last week at the Royal Society. He describes the different phases, saying, “Global health 3.0, which is still the main manifestation of global health, is about researchers from rich countries leading research programs in poor countries. But global health 4.0, increasingly the present and certainly the future, is research and other activities being led by researchers from low- and middle-income countries.” Smith states, “The 11 UnitedHealth/National Heart, Lung, and Blood Institute (NHLBI) centers are an example of global health 4.0,” and “are leading the way in that they are the only network of [non-communicable disease] researchers led from low- and middle-income countries.” He notes, “All the presentations from the meeting at the Royal Society and a brochure describing the work of the 11 centers can be accessed” online (10/8).